Sun Jae Jung

Background: While suicide represents a global health crisis, evidence examining the associations between physical activity and suicide-related outcomes remains fragmented. This umbrella review synthesized systematic reviews and meta-analyses examining relationships between physical activity and suicidal ideation, suicide attempts, and suicide death. Methods: We systematically searched PubMed, Embase, PsycINFO, Cochrane Library, and Web of Science from database inception to March 2025. Eligible studies included systematic reviews and meta-analyses examining physical activity or sports participation and suicide-related outcomes. Meta-analysis was not feasible due to methodological heterogeneity; narrative synthesis was performed. Evidence validity was assessed using established criteria (convincing, highly suggestive, suggestive, weak, nonsignificant), and methodological quality was evaluated using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews version 2). The protocol was preregistered on PROSPERO (CRD420251020494). Results: Six reviews met inclusion criteria. For suicidal ideation, physical activity showed potentially protective associations in general populations, adolescents, and athletes, but nonsignificant effects in clinical populations. For suicide attempts, potentially protective effects were observed across adolescents, clinical populations, and athletes, though no evidence was available for the general population. Evidence for suicide death was limited, showing mixed findings among athletes by sport type and nonsignificant associations in clinical populations. Most evidence was graded as weak validity due to small event sizes, modest statistical significance, and high heterogeneity. Conclusions: Physical activity shows potentially protective associations most consistently for suicidal ideation. In contrast, the evidence is more limited for suicide attempts and sparse for suicide death. The evidence base remains limited due to weak validity, small event sizes, methodological heterogeneity, and critical research gaps. Large-scale longitudinal studies with standardized protocols are needed to establish a more robust evidence base.

Aims: South Korea has one of the highest suicide rates among Organisation for Economic Co-operation and Development countries, and lower happiness has been associated with suicidal ideation and suicide attempts in Korean populations. We aimed to estimate a nation-level item network of happiness, affect, personality and well-being evaluations in South Korea and to test whether this network differed by sex, income and generation. Methods: We analysed 2020–2023 Korean Happiness Survey data from 64,531 respondents in South Korea; the network analyses used 61,675 complete cases. A Gaussian graphical model with Least Absolute Shrinkage and Selection Operator regularization estimated edges among happiness, affect, personality and well-being evaluations. Subgroup differences by sex, income and generation were assessed with permutation-based Network Comparison Tests. Results: The network contained 199 of 435 possible edges (45.7%). The strongest affective and happiness-related pairwise connections included happiness-enjoyment, stress-tiredness, sadness-depression and depression-anger. Global strength did not differ significantly across the planned subgroup comparisons, but network structure differed by sex, income, Millennials and Generation Z (MZ) versus Generation X, and MZ versus Baby Boomers. In the income comparison, happiness was more negatively linked to the agreeableness item ‘generally trusting’ in the low-income network, whereas its link with time for hobbies was stronger in the high-income network. In the generational comparison, the happiness-stress edge differed between the MZ generation and Baby Boomers, whereas no happiness-connected edge survived false discovery rate correction for MZ versus Generation X. No happiness-connected edge differed significantly by sex. Conclusions: In South Korea, happiness was most closely linked to enjoyment and embedded within tightly connected affective and evaluative domains. The subgroup differences were selective rather than global, suggesting that future work relevant to population well-being and suicide prevention may benefit from focusing on specific happiness-linked domains such as positive affect, stress-related ties, discretionary time and perceived future security.

Aims: Cardiovascular disease (CVD) risk may be under-recognized in young adults living with long-standing disability. We evaluated whether disability is associated with incident CVD risk in adults aged 20–39 years beyond conventional risk factors and whether risk varies by disability type, severity, and duration. Methods and results: We analysed 7 682 700 Korean adults aged 20–39 years without prior CVD who underwent national health screening (2009–14). Disability was ascertained using a standardized national registration system based on medical certification. Individuals with disabilities (n = 91 500; physical, brain lesion-related, sensory, or communication disabilities) were exact-matched 1:10 to non-disabled peers by age, sex, and index year. The primary endpoint was a composite of hospitalization for myocardial infarction, stroke, or heart failure, or cardiovascular death. Over a median follow-up of 11 years, 7925 participants developed CVD. Cardiovascular disease incidence was higher in individuals with disabilities than in matched controls (102.9 vs. 70.2 per 100 000 person-years), and disability remained associated with increased risk after comprehensive adjustment for sociodemographic factors, comorbidity burden, health behaviours, and cardiometabolic risk factors (hazard ratio, 1.34; 95% confidence interval, 1.25–1.44). Risk varied by disability type (highest for brain lesion-related disability) and increased with greater severity. Similarly, CVD risk increased gradually with longer disability duration. Conclusion: In young adults, disability is associated with higher incident CVD risk independent of conventional risk factors, with heterogeneity by disability type and gradients by severity and duration. These findings support earlier preventive attention and monitoring within disability care pathways in young adulthood.

Background: Timely detection of suicide warning signs is important for suicide surveillance and prevention, but little is known about how these signs are distributed across pre-death time periods at the population level.Objective: This study aimed to characterize the temporal distribution of suicide warning signs prior to death and to examine how the types of warning signs vary across different pre-death time periods.Methods: We retrospectively analyzed 102,888 suicide decedents aged ≥10 years using the Korean National Investigations of Suicide Victims Through Police Records (2013–2020). Warning signs were classified into verbal, behavioral, and emotional domains. For temporal analyses, we included decedents with at least one documented warning sign and non-missing timing information. Timing was grouped into six intervals from within 1 week to over 1 year before death.Results: Warning signs showed marked temporal clustering, especially within 1 week before death and more than 1 year before death. Within 1 week of death, warning signs were predominantly verbal (55.0%), most commonly references to suicide or death (23.5%). More than 1 year before death, warning signs were more often emotional (40.7%), particularly depressed mood (24.2%), and behavioral signs such as self-harm, prior suicide attempts, or substance use (16.8%).Conclusions: Suicide warning signs showed distinct temporal patterns before death, with differences in the prominence of verbal, behavioral, and emotional signs across time. These findings highlight the importance of considering temporal dynamics in suicide warning signs and may inform more time-sensitive approaches to surveillance and prevention.